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'''''The M.D.: A Horror Story''''' (1991) is [[Thomas M. Disch]]'s second ''Supernatural Minnesota'' novel. Sharing most of its setting and time period with ''[[The Businessman]]'' (although, unlike that book, there is also a speculative part of the story that takes place in the then-near-future of 1999), it describes the rise and fall of Billy Michaels, a medical doctor with dangerous magic powers over health and disease.

All notes refer to the 2010 University of Minnesota Press edition, which has a very good introduction by John Clute. 

== Major characters ==
* Billy Michaels, later Dr. William Michaels.
* Henry Michaels, his father.
* Sondra Winckelmeyer, his mother, now married to Ben Winckelmeyer.
* Madge Michaels, Henry's wife.
* Mrs. Obstschmecker, Madge's mother.
* Ned Hill, Madge's son from her first marriage.
* Lance Hill, Ned's father.
* Judith Winckelmeyer, Sondra's stepdaughter.
* Mercury, a.k.a. Santa Claus, a god.

== Epigram ==
The cited ''New York Times'' article<ref>Nelson, Bryce. [http://www.nytimes.com/1983/10/11/science/children-who-kill-personality-patterns-are-identified.html?pagewanted=all&mcubz=1 "Children Who Kill"]. ''The New York Times'', October 11, 1983. Retrieved September 11, 2017.</ref> is ironic in the context of ''The M.D.'', since it emphasizes the role of severe early trauma in molding a homicidal child. Billy Michaels may be what the article describes as a "nonempathic murderer," one of those without "the psychological ability to put themselves in the place of another," but his relatively sheltered childhood is almost exactly the opposite of people in that category who are said to have "a history of assaultive behavior, severe reading problems and inability to cope with stress." Disch may be implying that if such a person can in fact develop simply through intellectual curiosity, then it's not really the case that "the average American parent doesn't need to fear being murdered."

== Chapter 1 ==

=== Sister Mary Symphorosa ===
Named after a [[wikipedia:Symphorosa|2nd century martyr]]. Disch wrote in "My Life as a Child" that this character and her crusade against Santa Claus were based on a nun who taught him in kindergarten at St. Paul's Convent School in Fairmont, Minnesota (where there was also a Sister Fidelis; we'll see in chapter 57 that Sister Fidelis, the more benevolent of the nuns, ends up joining a liberal reform movement in the Church).{{ref Disch child}} Despite her abusive behavior, he was not without sympathy: "I think I give her honorable reasons for doing what she did .... [she's] right in saying that Santa Claus is pernicious, that teaching people to believe something you know they're going to find out is a lie is teaching them disbelief."{{ref Disch SF Eye}}

=== When meat isn't properly preserved ===
This passage foreshadows two important events later in the book, one involving contaminated meat, the other about an effective way to preserve corpses.

== Chapter 2 ==

=== Mrs. Obstschmecker ===
Her last name in German means "fruit-taster." Of the real-life inspiration for this character, Disch wrote that "Grandma Disch was resurrected to play the role of Grandma Obstschmecker,"{{ref Disch child}} and called her "a crippled, mean-spirited, small-minded German Catholic."{{ref Disch autobio}} However, whereas his own grandmother punished one of her daughters for marrying a divorced man by never speaking to her again, Mrs. O. is somewhat more forgiving (or at least less assertive) and expresses her disapproval of Madge's marriage only passive-aggressively.

=== the entire length of Calumet ===
The same [[The Businessman#a corner lot on Calumet Avenue|fictional street]] where Joy-Ann Anker lives in ''[[The Businessman]]''. All of the other place names in the book are also fictional, or at least belong to other cities rather than Minneapolis/St. Paul.

== Chapter 3 ==

=== when they got Dutch Elm disease ===
See [[The Businessman#elms you used to see shading Calumet Avenue in the days before the blight|''The Businessman'']].

=== Billy could only see things this other way ===
One of two hints (the other being in chapter 6) that Billy has an innate psychic gift and/or a neurological disease even before he makes his deal with Mercury.

== Chapter 5 ==

=== Father Windakiewiczowa ===
See [[The Businessman#Father Windakiewiczowa|''The Businessman'']].

== Chapter 7 ==

=== impeaching the president ===
Books One and Two take place in 1973-74, when Billy is 6 and 7. Billy turns 13 in Book Three, placing the middle section of the novel in 1980-81 like ''[[The Businessman]]''.

=== Billy Graham was on the news ===
[[wikipedia:Billy Graham|Graham]], as the first evangelical minister to develop a mass following on television, is an obvious forerunner to the digital-age Brother Orson later in the novel.

== Chapter 8 ==

=== horror movie called ''The Exorcist'' ===
''The Exorcist'' was released on December 26, 1973, just a day before this scene.

=== his caduceus is now a symbol of the science of medicine ===
Although a common belief, this is not quite right: the traditional medical symbol is the somewhat similar {{wp|rod of Asclepius}}, which has only one snake and no wings; the {{wp|caduceus as a symbol of medicine}} developed in the 20th century, by mistake. It's unclear whether Disch himself confused the two, or meant this as another example of Mercury's untrustworthy nature, since in chapter 10 Mercury mentions two contradictory stories about the caduceus.

=== his real father ... sold the ''Junior Universe of Knowledge Encyclopedia'' ===
Disch's father was a door-to-door salesman dealing in, among other things, the ''Britannica Junior''.{{ref Disch autobio}}

=== if the bad witch was making people sick, the good witch could make them better ===
An ironic statement considering how Billy's magic will work: the good and bad witch are the same person, and can never undo a curse once it's been made.

== Chapter 9 ==

=== the king of Bowling Pin Kingdom ===
As a kindergartener, the young Disch liked to play with "two sets of bowling pins (children and grown-ups) in enactments of my own fairy tales."{{ref Disch autobio}} In the same essay, he mentions having been able as a child to "cross my eyes, stare up at the ceiling, and watch self-projected home movies in wide-screen color" much as Billy does.

=== the Hanging Gardens of Wyomia ===
Could be just a child's wordplay on Wyoming, or a reference to the sprinter {{wp|Wyomia Tyus}} who would have been in the news in 1973.

== Chapter 12 ==

=== Power is never free. It must be paid for ===
Mercury is clearly implying that he is bestowing this power on Billy, which is probably the impression most readers come away with. But—given the earlier hints that Billy was already special in some way, and the careful wording of Mercury's promise in chapter 10 that he would ''tell'' Billy how to use the caduceus—another possible interpretation is that Billy always had the ability to use it, and only lacked knowledge of the rules. If that's the case, he's just been tricked into signing his soul away for basically nothing.

== Chapter 13 ==

=== Billy was only just turned seven ===
In a story with so strongly Catholic a setting, the age of seven is significant because it's traditionally the [[wikipedia:Person (canon law)#Age of Reason|age of reason]], after which a child is said to have moral responsibility. Billy made his bargain with Mercury just before turning seven, so according to this tradition he can't be considered responsible for it; but his first use of the caduceus to harm a person happens after his seventh birthday.

== Chapter 16 ==

=== the Vigil of Saman ... the Druid god of Death ===
Although the kind of children's encyclopedia Disch is imitating here might well have given such an explanation, it's etymologically wrong: [[wikipedia:Samhain#Etymology|several sources concur]] that Shamhna/Samhain is derived from words referring more generically to the idea of a festival or a season. Bruce Robinson argues that there is little to no evidence that the holiday was named after any "god of Death," but that Christian writers started perpetuating this error in the 18th century and have spread it into popular culture.<ref>Robinson, Bruce. [http://www.religioustolerance.org/hallo_sa.htm "About Halloween: The myth about the 'Celtic god of the dead.'"] ''Religious Tolerance'', October 22, 2015. Retrieved September 11, 2017.</ref> But, as with all of Mercury's/Santa's other statements so far, any inaccuracies that could be the author's fault could also be blamed on the god just reflecting back to Billy whatever ideas Billy has already picked up.

=== What rhymed with "now"? ===
Since we never see the words of the curse Billy eventually writes for this purpose, Disch seems to be inviting the reader to guess what this rhyme is from context. Based on the events of chapter 19 when the curse takes effect, a logical conclusion would be that Billy attached the curse to Madge's fifth of vodka in the freezer—although if so, either he didn't do it till later or else it had a long delay, since Madge was able to have a drink with no problem in chapter 18. In any case, I can't think what the rhyme would be.

== Chapter 21 ==

=== She's not a witch .... She's St. Clare ===
{{wp|Clare of Assisi}} was a follower of St. Francis. As she was not a martyr and was not known for any visually distinctive miracles, a St. Clare costume would simply consist of cheap ascetic clothes. She is also officially the patron saint of television.

== Chapter 30 ==

=== Dr. Helbron ===
This character appears briefly in ''[[The Businessman]]'' as the psychiatrist for both Robert Glandier and Jack Sheehy.

== Chapter 31 ==

=== Bishop Cretin High School ===
A real school that Disch attended in the 1950s.{{ref Disch child}}

=== Willowville, New Hope, and the other north-lying suburbs ===
Willowville, where the Winckelmeyer family lives, is fictional, and is mentioned briefly in ''[[The Businessman]]''. New Hope is about five miles northwest of downtown Minneapolis.

== Chapter 33 ==

=== a girl in New Jersey or somewhere like that ===
{{wp|Karen Ann Quinlan}} was from Pennsylvania, but ended up in a coma in New Jersey (at St. Clare's Hospital) after an overdose. In 1980, she was still alive, having already survived for four years after her parents decided to remove her from the ventilator (but to continue the feeding tube).

== Chapter 41 ==

=== Ondine's curse ... was also connected with sleeping ===
This is correct: {{wp|central hypoventilation syndrome}} normally shows up during sleep. Disch never spells out why Billy's victim died immediately instead, but one possibility is that the curse relied only on the literal words Billy had read about the disease, which did not specify sleep, rather than his logical assumptions about it.

=== Mississippi—Father of Waters ===
The statue described here is "Father of Waters" by Larkin Goldsmith Mead, which in reality is at [[wikipedia:Minneapolis City Hall#Interior|Minneapolis City Hall]].

== Chapter 44 ==

=== honor that king, and make the day of his birth their holiday ===
Although Icksy started out by talking about her son Reinhardt, this prophecy might refer to a different King: {{wp|Martin Luther King Jr. Day}} was designated a federal holiday in 1983. There is a strong strain of racial paranoia running throughout Billy's childhood—realistically portrayed as something he's picked up from many casual remarks from the adults in his life—so it's not surprising that his dream depicts this vengeful character as being Black. A more sympathetic portrayal of African-Americans will have to wait for Book Five, when we escape from the point of view of Billy and his immediate family.

=== that child shall have no name ===
This prophecy is fulfilled in chapter 52.

=== your judge's name is— ===
We'll meet this person in chapter 56.

== Chapter 46 ==

=== The Population Explosion ===
This is also the title of a [[Camp Concentration/Book Two#Riesman|satirical story]] written by the narrator of ''[[Camp Concentration]]'' about the sociopathic scientist Dr. Skilliman; in the story, Skilliman decides to address the titular problem by murdering a single baby.

== Chapter 52 ==

=== Bradley-Chambers syndrome ===
This congenital disorder is fictional, and combines the features of many real kinds of birth defects. It is referenced, with language clearly derived from ''The M.D.'', in fantasy author James Morrow's play ''The Soap Opera''.<ref>Morrow, James. "Bible Stories for Adults, No. 46: The Soap Opera". In ''Bible Stories for Adults''. Mariner Books, 1996. ISBN 0156002442</ref>

== Chapter 56 ==

=== priests getting married and women becoming priests ===
One of the non-technological signs that we are now in a speculative near-future world: a branch of the Catholic Church has split off from Roman authority and embraced many liberal reforms. This will be explored in more detail in the next chapter.

=== a follower of Brother Orson ===
Brother Orson will be described in chapter 58.

== Chapter 57 ==

=== Imani Temple ===
''Imani'', Swahili for "faith," is probably best known in the US as one of the principles of {{wp|Kwanzaa}}.

=== his favorite Josephan detox center ===
That is, a detox center devoted to St. Joseph (whose name is used by many medical facilities across the country). Disch said this about the character of Youngermann: "Half the priests in the country are in and out of detox. It's the chief occupational hazard of being a Roman Catholic priest, because they have to drink wine every morning."{{ref Disch SF Eye}}

=== Fathers .... not always around when you need them ===
William Michaels embodies this idea in several ways: his biological father, Henry, died as an indirect result of William's actions; his stepfather, Ben, went to jail, also indirectly thanks to William; and William was an absentee father during his own son Judge's formative years. While it might have been a good thing for Judge to be out of his father's influence, his growing up in the Bible Belt due to William's destruction of Judith's family probably contributed to his conversion to radical fundamentalism.

=== strikes down anyone it takes a fancy to ===
Lyman is referring to the reason ARVIDS is named as it is: "acute random-vector immune dysfunction syndrome" (see chapter 73). A vector is an organism or substance that carries the disease-causing agent, so this is simply saying that unlike AIDS, there's no known pattern of who gets the new plague, or how.

== Chapter 58 ==

=== the Kiss of Peace ===
The kiss or [[wikipedia:Kiss of peace|sign of peace]] has been a part of regular Catholic Mass since 1969, but in many US congregations it is replaced with a handshake.

=== Brother Orson holds out little hope of salvation for the sons of Ham ===
In other words, Brother Orson's movement is an explicitly racist one along the lines of {{wp|Christian Identity}}. "Sons of Ham" in this sense dates back to the 17th or 18th century, from the idea that the biblical {{wp|curse of Ham}} had been passed down to Africans who were therefore predestined to be enslaved. Lyman is basically daring Judge to disavow this extremely offensive phrase, and Judge fails the test.

=== some book that was sealed with seven seals ===
Judge is holding forth about the {{wp|Book of Revelation}}, which is commonly interpreted in evangelical Protestantism as a prophecy of the end of the world, but in Catholicism is considered more of a metaphorical curiosity and not part of the Bible.

=== the image you ''see'' on the TV ... it's like a cartoon ===
Lyman is describing a computer-animated figure that responds to individual viewers (although not every viewer has this "interactive capability," which presumably is a premium service). That this is described as a TV program rather than an online service is a sign of the book being written in 1990-91 rather than a few years later—although, with the rise of streaming Internet channels that are commonly described as "TV," it's become a more accurate prediction again.

=== those little dots sprinkled on the TV screen ===
Reminiscent of how Billy's early visions of Mercury are described in chapter 3.

=== Oliver North ===
Former Marine Lieutenant Colonel {{wp|Oliver North}} was best known for participating in the Reagan administration's illegal arms sales to Iran, covert support of the Nicaraguan Contras, and cover-ups of these actions. His convictions on three related crimes in 1989 were later reversed, and he became a hero to right-wingers who supported Reagan's Central American policies. Disch's idea that North would end up in the US Senate was only a slight exaggeration: North ran for the Senate in 1994, but lost by a three-percent margin.

== Chapter 59 ==

=== a chain of hotels, a prison system, and a realty and construction company ===
In the US, [[wikipedia:Private prison#In the United States|privatized prisons]] in the modern sense began in 1984, and were immediately controversial but have continued to grow ever since. Disch anticipated this trend in a somewhat different way five years earlier in ''[[On Wings of Song]]'', where the prisons are set up on such a laissez-faire model that they have hardly any staff.

=== To keep Northwestern out of Onamia ===
{{wp|Onamia, Minnesota}} is a small town about 90 miles north of Minneapolis.

== Chapter 60 ==

=== dangers from father, brother, and son ===
Disch quoted this in an interview as "father, brother, ''or'' son"{{ref Disch SF Eye}}, which makes the pun of "Brother Orson" more explicit. (In the same interview, Disch responded to a suggestion that Brother Orson might also have been named for a fellow SF author, such as the notably right-wing Orson Scott Card, by drily stating, "I can't think of any science fiction figure by that name.") Still, the word is "and" in the first edition of the novel<ref>Thanks to John Stick for confirming this.</ref> as well as the most recent one.

In any case, William does in fact face dangers from ''all'' of those: his son Judge and his stepbrother Ned will become significant figures in his downfall, and his dead father Henry contributed supernaturally to Judge's conception (chapter 51) as well as providing an important genetic factor.

It is probably not a coincidence that almost this exact language—"father, brother, or son"—is commonly used on medical history questionnaires, patient education literature, etc.<ref>See, for instance, the results of a web search for [https://www.google.com/search?q=%22father+brother+or+son%22+medical+history "father brother or son" medical history].</ref> when discussing heritable conditions that could show up in a close male relative.

=== unforeseen and unfortunate results ===
Mercury is of course not giving William enough information to actually avoid the trap he will fall into; in light of later events, this whole passage could be considered a self-fulfilling prophecy similar to [[The Businessman#I am going to kill you|the one in ''The Businessman'']]—since the decision William makes in chapter 61, based on his fear of the prophecy, leads to much worse problems for him than if he had gone ahead with his original plan.

Chains of cause and effect are prominent throughout the book, despite usually not being spelled out; at this point, virtually every aspect of the condition of Billy's extended family is either a direct or indirect result of one of his curses.

== Chapter 61 ==

=== The Great Plains are drying up ===
It's never explicitly stated that William is in some way responsible for these signs of climate change, but it's possible given his previous experiments on plant and insect life.

=== You'll linger half-alive for years ===
It should be no surprise that this curse will eventually find a target; this happens in chapter 66.

== Chapter 62 ==

=== the parents ... had lived at the extreme edge of destitution ===
This is one of the clearest examples of a less dramatic side to William's corruption: besides cursing countless people, he's also so disconnected from regular human concerns, and from his own childhood, that in his millionaire years he hasn't given any thought or help to people like his former neighbors. His creation of the clinic where Bubby ends up, though it benefits many people, is arguably motivated by guilt over Ned; similarly, his impulsive decision to try to help a stranger in chapter 66, which contributes to his doom, isn't purely altruistic since the stranger only needed help because of William's destructive schemes.

== Chapter 63 ==

=== After the Fourth it'll be too late ===
Since Madge's instructions to her mother in chapter 62 established that it's now June, Judge's birthday must be the [[wikipedia:Independence Day (United States)|fourth of July]].

== Chapter 68 ==

=== the first to be blighted by William's curse .... The fabric was unraveling ===
For such a significant plot development as Ned's emergence from paralysis, Disch's refusal (even as an omniscient narrator) to state its exact cause is somewhat frustrating, but typical. In the context of just this chapter, one might assume that there's something special about Lance's touch that broke the spell. But a simpler explanation is an event that took place without any fanfare in chapter 62: William put a curative spell on Robert Corning, who, though William didn't realize it, was "Bubby"—and the curse on Ned in chapter 13, rather than specifying a particular disease, compelled him to ''be like Bubby''.

As for why this would set off such a dramatic series of failures in all of William's magic: two rules Mercury has emphasized again and again are that the caduceus's power depends on consistently harming more people than it helps, and that a curse cannot be undone. William has accidentally found a loophole to the second rule (Ned is healed by healing someone else who was not cursed)—and has annulled the curse that had provided the power, like a seed investment, for all his subsequent actions.

== Chapter 70 ==

=== plenty of room in the freezer ===
A character ''almost'' discovering murder evidence in a freezer is also [[Roderick/Book Two#Rogers and his ultra-modern kitchen ... I tried to get into his freezer|a plot point]] in ''[[Roderick]]'', by Disch's friend John Sladek.

== Chapter 71 ==

=== that plague had raged, and then, for no known reason, it had stopped ===
Disch may be implying that a predecessor to William Michaels was responsible for the {{wp|Black Death}}.

== Chapter 73 ==

=== ''Mycoplasma incognitus'' ===
The idea that ARVIDS has a known microbial agent may seem odd since we've previously heard that its mode of transmission can't be identified. However, ''{{wp|Mycoplasma}}'' organisms are so small that they often cannot be seen microscopically (more sensitive {{wp|PCR}}-based tests were not as common in 1991 as they are now), so researchers might know that this microbe is only found in plague victims but still be unable to determine how people are acquiring it.

This does not necessarily contradict the plague's magical origins; as seen in ''[[Camp Concentration]]'', Disch was very familiar with Thomas Mann's ''Doctor Faustus'', in which the syphilis bacteria infecting the protagonist's brain are described as being the low-level agents of his deal with the Devil.

== Chapter 79 ==

=== MEAT—8 pounds ===
Judge's guess is not far off: the average weight of a human head, depending on whom you ask,<ref>Gekhman, Dmitriy. [https://hypertextbook.com/facts/2006/DmitriyGekhman.shtml "Mass of a Human Head"]. ''The Physics Factbook'', 2006. Retrieved September 15, 2017.</ref> is somewhere between 8 and 12 pounds.

== Chapter 81 ==

=== a simple compound beat, systole and diastole ===
Two phases of a [[wikipedia:cardiac cycle|heartbeat]].

== Chapter 82 ==

=== The room was full of smoke ===
The second instance in the Supernatural Minnesota series of a [[The Businessman#in the Sheehys.27 burning home|burning house]].

== Further reading ==

* [http://www.upress.umn.edu/book-division/books/the-m-d University of Minnesota Press page] for their edition
* [http://www.ukjarry1.talktalk.net/md.htm Matthew Davis's page] for the book - lists all the known editions and translations
* [https://www.tor.com/2010/11/09/guided-tour-supernatural-minnesota-md/ Review and discussion] by Ron Hogan on tor.com

== Footnotes ==
<references/>

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